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52 Cards in this Set
- Front
- Back
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What is the motto of surgical nutrition? |
"If the gut works, use it" |
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What are the normal daily dietary protein requirements for adults? |
1 g / kg / day |
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What are the normal daily dietary caloric requirements for adults? |
30 kcal / kg /day |
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By how much is basal energy expenditure (BEE) increased or decreased in pts with severe head injury? |
Increased ~1.7x |
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By how much is basal energy expenditure (BEE) increased or decreased in pts with severe burns? |
Increased ~2-3x |
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What is the calorie content of fat? |
9 kcal/g |
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What is the calorie content of protein? |
4 kcal/g |
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What is the calorie content of carbohydrate? |
4 kcal/g |
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What is the formula for converting nitrogen requirement / loss to protein requirements / loss? |
Nitrogen x 6.25 = protein |
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What is RQ? |
Respiratory Quotient: ratio of CO2 produced to O2 consumed |
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What is the normal RQ? |
0.8 |
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What can be done to decrease the RQ? |
More fat, less carbohydrates
(decreased RQ = decreased CO2 produced relative to O2 consumed) |
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What dietary change can be made to decrease CO2 production in a patient in whom CO2 retention is a concern? |
Decrease carbohydrate calories, and increase calories from fat |
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What lab tests are used to monitor nutritional status? |
Blood levels of: - Pre-albumin (t1/2 = 2-3 days) - Transferrin (t1/2 = 8-9 days) - Albumin (t1/2 = 14-20 days - Total lymphocyte count - Anergy - Retinol-binding protein (t1/2 = 12 hours) |
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Which lab test is good for assessing acute change in nutritional status? |
Pre-albumin (t1/2 = 2-3 days) |
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Which lab test is good for assessing chronic change in nutritional status? |
Albumin (t1/2 = 14-20 days) |
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Where is iron absorbed? |
Duodenum (proximal jejunum) |
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Where is vitamin B12 absorbed? |
Terminal ileum |
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What are the surgical causes of vitamin B12 deficiency? |
- Gastrectomy - Excision of terminal ileum - Blind loop syndrome |
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Where are bile salts absorbed? |
Terminal ileum |
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Where are fat-soluble vitamins absorbed? |
Terminal ileum |
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Which vitamines are fat soluble? |
A, D, E, K |
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What are the signs of Vitamin A deficiency? |
Poor wound healing |
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What are the signs of Vitamin B12 / Folate deficiency? |
Megaloblastic anemia |
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What are the signs of Vitamin C deficiency? |
Poor wound healing, bleeding gums |
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What are the signs of Vitamin K deficiency? |
Decrease in vitamin K-dependent clotting factors (II, VII, IX, X); bleeding; elevated PT |
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What are the signs of Chromium deficiency? |
Diabetic state |
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What are the signs of Zinc deficiency? |
- Poor wound healing - Alopecia - Dermatitis - Taste disorder |
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What are the signs of fatty acid deficiency? |
- Dry, flaky skin - Alopecia |
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What vitamin increases the PO absorption of iron? |
PO vitamin C (Ascorbic Acid) |
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What vitamin lessens the deleterious effects of steroids on wound healing? |
Vitamin A |
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What are the common indications for total parenteral nutrition (TPN)? |
- NPO > 7 days - Enterocutaneous fistulas - Short bowel syndrome - Prolonged ileus |
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What is TPN? |
Total Parenteral Nutrition = IV nutrition |
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What is TPN? |
- Protein - Carbs - Lipids - (H2O, electrolytes, minerals/vitamins, +/- insulin, +/- H2 blocker) |
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How much lipid is in TPN? |
20-30% of calories (lipid from soybeans, etc) |
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How much protein is in TPN? |
1.7 g / kg / day (10-20% of calories) as amino acids |
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How much carbohydrate is in TPN? |
50-60% of calories as dextrose |
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What are the possible complications of TPN? |
- Line infection - Fatty infiltration of liver - Electrolyte / glucose problems - Pneumothorax during placement of central line - Loss of gut barrier - Acalculus cholecystitis - Refeeding syndrome - Hyperosmolality |
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What are the advantages of enteral feeding? |
Keeps gut barrier healthy, thought to lessen translocation of bacteria, not associated with complication of line placement, associated with fewer electrolyte / glucose problems |
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What is the major nutrient of the gut (small bowel)? |
Glutamine |
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What is "refeeding syndrome"? |
Decreased serum K+, Mg2+, and PO4 after refeeding (via TPN or enterally) a starving pt |
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What is an elemental tube feed? |
Very low residue tube feed in which almost all of the tube feed is absorbed |
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Where is calcium absorbed? |
- Duodenum (Actively) - Jejunum (Passively) |
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What is the major nutrient of the colon? |
Butyrate (and other short-chain fatty acids) |
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What must bind B12 for absorption? |
Intrinsic Factor from the gastric parietal cells |
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What sedative med has caloric value? |
Propofol delivers 1 kcal/cc in form of lipid |
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Why may all insulin placed in TPN bag not get to pt? |
Insulin will bind to IV tubing |
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What is the best way to determine the caloric requirements of a pt on the ventilator? |
Metabolic chart |
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How can serum bicarb be increased in pts on TPN? |
Increase acetate (which is metabolized into bicarb) |
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What are trophic tube feeds? |
Very low rate of tube feeds (usually 10-25 cc/hr) which are thought to keep mucosa alive and healthy |
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When should PO feedings be started after a laparotomy? |
Classically after flatus o stool PR (usually post-op days 3-5) |
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What is the best parameter to check adequacy of nutritional status? |
Pre-albumin |
